Stroke – the most important facts at a glance

1. What is a stroke?
2. What are the consequences of a stroke?
3. What increases the risk of a stroke?
4. How can a stroke be prevented?
5. How are stroke, diabetes and obesity related?
6. What are the symptoms of a stroke?
7. How is a stroke diagnosed?
8. How is a stroke treated?

A stroke often results in considerable restrictions in bodily functions. “Time is brain”: The faster people are treated after a stroke, the fewer brain cells die and the better the prognosis.

The physical consequences of a stroke can vary depending on the severity and theaffected area of the brain. The consequences include above all:

• Paralysis or weakness and pain in various parts of the body, i.e., restrictions when walking or standing
• Coordination difficulties and restrictions in fine motor skills, i.e., difficulties lifting objects, writing or eating
• Speech disorders
• Difficulty swallowing

There are many factors that can influence the risk of a stroke. A distinction can be made between modifiable and non-modifiable factors.

The non-modifiable risk factors include

• Age: The risk of stroke increases with age.
• Gender: Men are more likely to suffer a stroke at a younger and middle age than women. At an older age, however, women have a higher stroke risk – especially if they have diabetes. Due to the longer life expectancy of women, they are more frequently affected by strokes. Due to their older age, the consequences of a stroke are often more severe in women than in men.
• Genetics: People with a known family history of stroke (grandparents, parents) may have a higher risk of suffering a stroke.

There are also some modifiable risk factors. These include:

• High blood pressure
• Lack of physical activity
• Severe overweight (obesity)
• Atrial fibrillation, diseases of the heart valves or other heart diseases
• Alcohol and/or drug consumption
• Poorly adjusted blood sugar level (blood glucose level)

The good news: Approximately 80 in 100 strokes are preventable. Medical associations recommend the following measures, among others:

• Blood pressure: Check your blood pressure regularly. See your doctor if your blood pressure is elevated.
• Nutrition: Make sure you have a balanced diet with plenty of fruit, vegetables, wholegrain products, protein-rich products such as pulses, low-fat milk and dairy products, lean meat if any and “healthy fats” such as those found in nuts, vegetable oils and fish.
• Weight control: A healthy body weight also helps to reduce the risk of a stroke. The body mass index (BMI) of a person of normal weight is between 18.5 and 24.9 kg/m². A BMI of 25.0 to 29.9 kg/m² is indicative of overweight. A BMI of over 30 kg/m² is considered obesity.
• Physical activity: Exercise strengthens the cardiovascular system. At least 150 minutes of moderate-intensity exercise per week is recommended. In addition, as much exercise as possible should be incorporated into everyday life.
• Stop smoking: Smokers significantly increase their risk of suffering a stroke. This also applies to passive smoking, i.e., inhaling the cigarette smoke of others. Abstaining from smoking is one of the most important measures to prevent a stroke. You can find tips and contact points for quitting smoking here.
• Alcohol: Avoid alcohol or try to reduce your alcohol consumption. According to the latest scientific findings, even small amounts of alcohol are harmful to health.
• Keep stress to a minimum: Chronic stress can increase the risk of a stroke. Strategies for coping with stress, such as meditation, yoga or relaxation techniques, can help.
• Get enough sleep: Sufficient and high-quality sleep is important for general health. People with sleep apnea syndrome (breathing disorders during sleep) should seek treatment, as it may be associated with an increased stroke risk.

The symptoms of a stroke can vary depending on the severity and the affected area of the brain. However, there are signs that are indicative of a stroke. Neurologists have developed what is called the FAST rule. This rule helps outsiders to assess whether it is a stroke:

• Face: Ask the person to smile or move their face. Persons with a stroke may have difficulty controlling their smile or moving one side of their face.
• Arms: Sudden weakness or numbness in one or both arms is another possible indication. Ask the person to raise his or her arms. If he or she has difficulties to do so, this could indicate a stroke.
• Speech: Ask the person to repeat a sentence. If he or she fails to do so or speaks unclear or “slurred,” this provides further evidence of a stroke.
• Time: Time is crucial. If a stroke is suspected, you should make an emergency call (112 in Germany) immediately, regardless of whether the symptoms are temporary or not.

Other symptoms of a stroke may include sudden visual disturbances in one or both eyes, sudden dizziness, sudden difficulties with balance and sudden, severe headaches.

Are there warnings of a stroke?

A transient ischemic attack (TIA) is a possible warning of a stroke. In the event of a TIA, affected individuals experience a short period of neurological symptoms caused by a temporary interruption of the blood supply to the brain. In contrast to a stroke, the symptoms of a TIA last less than 24 hours. They often only occur for a few minutes.

The typical symptoms of a TIA include:

• Sudden visual disturbances in one or both eyes
• Sudden numbness or weakness in one arm, hand or leg, often on one side of the body
• Sudden confusion or difficulty speaking and understanding
• Sudden dizziness or loss of balance

Affected persons should take the symptoms of a TIA seriously. They indicate an increased stroke risk. It is important to seek medical help immediately to clarify the causes of the TIA and to take appropriate measures to prevent a stroke.

Doctors today have numerous options at their disposal for diagnosing a stroke:

• Case history: The doctor will ask about previous illnesses and complaints, especially vision problems, speech problems, numbness or weakness.
• Neurological examinations: Doctors use various tests to examine reflexes, coordination as well as motor and sensory skills. Sensory nerves transmit information from the senses (hearing, sight, taste, smell and touch) to the brain. Motor nerves send signals from the brain to the muscles.
• Imaging techniques: Computed tomography (CT) and magnetic resonance imaging (MRI, also known as “nuclear spin”) provide insights into the brain. This allows signs of a stroke such as hemorrhage or infarction to be detected.
• Laboratory values: Blood tests provide information about blood sugar levels, blood lipid levels and other factors that can increase the risk of vascular disease.
• Heart examinations: An electrocardiogram (ECG) shows whether, for example, cardiac arrhythmia or other heart diseases are present that could indicate a risk of suffering another stroke.

The treatment of a stroke depends on the type of stroke (ischemic or hemorrhagic) and the severity of the symptoms. Time is a decisive factor: Prompt treatment can significantly improve the chances of a full recovery.

In the event of an ischemic strokes, doctors try to dissolve the blood clot and restore blood flow using special medication. However, this thrombolysis is only effective within a time window of a few hours after the onset of symptoms. One possible alternative is to remove the blood clot mechanically (thrombectomy). This is done using a catheter, i.e., a very fine tube, which is inserted into the affected blood vessel and all the way to the blood clot.

In the event of a hemorrhagic stroke caused by bleeding in the brain, controlling blood pressure is important to reduce the hemorrhage and minimize further damage. If necessary, an attempt is made to reduce the pressure in the skull in a surgical procedure and thus relieve the pressure on the brain.

Regardless of the type of stroke, doctors often monitor and treat patients in what are called “stroke units.” These are departments that specialize in the treatment of strokes.

The prognosis after a stroke may vary greatly. It depends on several factors, above all on

• the severity of the stroke
• the affected region in the brain
• the time until the start of treatment
• the presence of other illnesses

Some people recover to a large extent and can lead a relatively normal life after several months, while others are impaired in the long term and need help.

Why is aftercare of a stroke so important?

After a stroke, there is a risk of another stroke occurring. This is exactly where secondary prophylaxis comes in. Doctors try to reduce this risk through a variety of measures. These measures are based on the patient’s individual situation.

Quitting smoking, a healthy diet, regular physical activity and a body weight within normal range are decisive factors in secondary prophylaxis after a stroke. Doctors often prescribe medication to reduce the risk of a new blood clot. The choice of medication depends on various factors, such as the patient’s state of health, other illnesses or intolerances to certain drugs.

It is also important to lower the values for people with high blood pressure (arterial hypertension). Suitable medication will be selected by your attending physician. In addition, drugs such as statins are often prescribed to lower cholesterol levels and reduce the risk of vascular calcification (arteriosclerosis) and blood clots. People with diabetes should monitor their blood sugar levels closely. It may be necessary to change the treatment according to medical advice.

What happens during rehabilitation after a stroke?

Rehabilitation, or rehab for short, after a stroke is important in order to restore physical functions and improve the quality of life of those affected. It begins in hospital, followed by rehabilitation in specialized facilities. Depending on the type and extent of the impairment(s), recovery after a stroke can take a long time. As no two strokes are the same, patients should talk to their doctors if they have any questions about the prognosis.

Inpatient rehabilitation is usually approved for 3 weeks. It covers different aspects depending on the restriction(s). For example, physiotherapy aims at improving muscle strength, coordination and balance. It can also help to restore mobility. Occupational therapy, on the other hand, is used to make patients fit for everyday life. That means that, depending on the nature of their impairment(s), patients learn to walk again, wash themselves, hold objects and much more.

Speech therapy is important if the stroke has impaired speech, language or swallowing functions. Patients improve their communication skills and learn how to deal with swallowing problems. Neuropsychological rehabilitation, on the other hand, focuses on brain functions such as attention, memory, thinking and problem solving.

In addition, psychologists support people after a stroke. Together they develop strategies for coping with stress and depression.

Many clinics instruct patients to train themselves later at home. The greatest progress can be made in the first 6 months.